Healthcare Provider Details

I. General information

NPI: 1033268750
Provider Name (Legal Business Name): ISLAND INSTITUTIONAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 CHISUM STREET POB 38
SICILY ISLAND LA
71368-0038
US

IV. Provider business mailing address

313 CHISUM STREET ISLAND INSTITUTIONAL PHARMACY, POB 38
SICILY ISLAND LA
71368-0038
US

V. Phone/Fax

Practice location:
  • Phone: 318-389-5807
  • Fax:
Mailing address:
  • Phone: 318-389-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9223
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number5055-IR
License Number StateLA

VIII. Authorized Official

Name: MR. A GIRAULT BIRD
Title or Position: OWNER
Credential: PHARMACIST
Phone: 318-389-5807